Expression of Interest Form 50th Anniversary

To help NFMRI celebrate its 50th Anniversary we are opening expression of interest for a single recipient to receive a project grant of up to $1 million. Your EOI must be accompanied by a letter of support from your tech transfer office and a maximum of three EOI are permitted from each publicly funded research organisation.

Expression of Interest (50th Anniversary)

This form is for researchers submitting an EOI. Please ensure that you have read our ‘applying for support’ information that includes information about our mission, strategy, exclusions, eligibility criteria and process before proceeding. Inclusion of items that are excluded or not eligible for NFMRI funding will disqualify your application.

Step 1 of 3

Comments

This field is for validation purposes and should be left unchanged.

Contact Information

Chief Investigator(Required)

Prefix First Initial Last

Organisation(Required)

Position(Required)

Department or Institute(Required)

ORCID number

How long have you been employed by this organisation (years)(Required)

Please enter a number from 1 to 40.

What is your position's renewal date(Required)

Your Email Address(Required)

Enter Email Confirm Email

Your Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region Postcode Country

Organisations website

Please paste your full URL here.

Administering Institution

Registered name(Required)

ABN(Required)

Contact Person(Required)

First Last

Phone(Required)

Email(Required)

Postal address(Required)

Street Address Address Line 2 City State / Province / Region Post code Country

DGR Status

DGR1

DGR2

Proposal Overview

Project Name(Required)

Grant round(Required)

Grant rounds are open to portfolios 2 & 3 only.

Primary Indication(Required)

Select a primary disease or condition

Requested amount(Required)

How much is this grant requesting

Total program budget(Required)

Total of all funding going for the program

Percentage of Total Budget

Grants: Research Portfolio(Required)

Note: Portfolio 1 is only open in our Alzheimer’s disease grant round

Innovation(Required)

What is the primary regulated product

Starting Date(Required)

Completion Date(Required)

Multi year(Required)

Yes

Duration (years)(Required)

Overview of the project(Required)

Outline who may benefit from this innovation. Why is there a need and what alternatives exist or are in development.

Strategic fit(Required)

Briefly describe the innovation and how it aligns with the Foundation’s mission and strategy.

Portfolio alignment(Required)

Briefly outline why this EOI aligns with the selected portfolio. Highlight the need for funding, co-investigators and groups performing the research.

Research

Non-confidential lay descriptions requested throughout

Aims of the research (lay descriptions)(Required)

Outline the aims of the research

Does the research utilise quality systems?

ISO

GLP

GMP

Milestones(Required)

Please indicate your key milestones, completion dates and associated budget. (Max=10)

Milestone

Completion Dates

Budget

Your innovation(Required)

Outline evidence to support the potential of your innovation and any competitive advantage. You may attach a single page PDF of data and tables at the end of the form.

Translational pathway(Required)

Briefly describe the likely translational pathway.

Advancing the innovation(Required)

Briefly describe the research this grant will support and how it relates to advancing the innovation. Refer to the current stage, known research outcomes and the importance of the study to be undertaken in securing next-step partners.

You may upload a single page PDF of data and charts to support your EOI at the end of this form before submitting. Save and continue does not save uploaded forms.

Translation experience(Required)

Briefly outline your experience in innovation, commercialisation and collaborations. What support is available through your institution for this project.

Current and Past Funding

Sources of funds(Required)

Please include all funds associated with this innovation. (Max=10)

Year from

Year to

Source (eg NHMRC)

Amount

Intellectual Property

Is their IP arising from this research(Required)

Yes

Has an invention disclosure form been filed with your institution(Required)

Yes

Intellectual Property(Required)

Please identify all owners, inventors and rights holders for the innovations IP and outline how the IP is being managed.

Patent filings(Required)

Please list any patent filings associated with this innovation. (Max=10)

Date

Filing number

Stage (eg PCT)

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